This form is available to UMKC Dental Alumni to register their e-mail address. After filling out the form below, your updated information will be automatically e-mailed to the Dental Alumni office for processing.

Code Number
The number found near your name and address on the post card you received (this number is “optional”)
First Name
Last Name
Program
Not Specified
D.D.S.
Dental Hygiene
Advanced Education
(specify)
Year of Graduation
E-mail address
Preferred Street Address
City
State
Zip
Daytime Phone
Fax